A patient with anemia may not have adequate red blood cells to carry oxygen throughout the body. This can cause a variety of symptoms, including fatigue, shortness of breath, and heart palpitations. The cause of this condition can also be due to lack of iron in the diet, vitamin B12 deficiency (pernicious anemia), lead poisoning, kidney failure, etc.
This blog post will cover what anemia is, how to diagnose it, and care plans for patients to guide you as a student. As you read, keep it in mind that our top writers are ready to help in case you get stuck with your assignment. All you need to do is place an order with us!
Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
Anemia is a disorder of the red blood cell [RBC]. It’s characterized by less than the normal number of RBCs or a decrease in hemoglobin concentration, resulting in decreased oxygen-carrying capacity (American Nurses’ Association [ANA], 2008).
Anemia is caused by either decreased production or increased destruction of red blood cells. The most common cause of anemia is due to insufficient dietary intake of iron from meat, poultry, or vegetables and poor absorption. Other causes are: loss of blood or chronic bleeding, bone marrow disease, immunodeficiency disorders, blood dyscrasias (abnormal blood conditions), hemolytic anemia – red blood cells are destroyed or removed by the spleen, kidneys, and other organs.
The following are signs and symptoms of anemia:
- Lightheadedness, fatigue, lack of energy, and shortness of breath
- Heart murmur, cardiac palpitations, or chest pain (client’s pulse may feel rapid or “flip-floppy”)
- Pale appearance, graying or yellowing of nails and skin; brittle nails are a result of anemia rather than aging
- Headaches when standing up from lying down
- Tissue hypoxia and hypoperfusion (lack of oxygen-carrying blood to tissues caused by heart failure or shock)
- The pallor of mucous membranes
- Delayed capillary refill time
Referrals should be made if the client demonstrates any signs and symptoms that are not being managed. Some examples include bone pain, fever with myalgia (muscle pain), pica, purpura, or any signs of infection.
The client is at risk for falling and fractures due to a lack of oxygen supply to the brain.
Without adequate hematopoiesis, the bone marrow will not produce sufficient amounts of red blood cells (RBCs), leading to anemia. Specific risk factors include:
- Autoimmune conditions such as rheumatoid arthritis or lupus
- Complications following surgery, chemotherapy, radiation therapy
- Diseases affecting the blood vessels (e.g., sickle cell anemia)
- Disorders affecting bone marrow function or supply of nutrients to red cells (e.g., iron deficiency, thalassemia)
- Alcoholism or other forms of substance abuse
- Deficient intake or absorption of food nutrients
- Drug side effects
- Genetic-Inherited blood disorders such as thalassemia or sickle cell anemia
- Liver disease (e.g., hepatitis)
- Malignant tumors (many types), such as leukemia, lymphoma, and multiple myeloma
- Nutritional deficiencies (e.g., iron, vitamin B12, and folate) may cause megaloblastic anemia.
Most anemias are classified based on the cause of the disorder, e.g., acquired versus congenital hemolytic anemia.
Iron-deficiency anemia Iron-deficiency anemia is a disorder characterized by low levels of red blood cells (RBCs) in the body due to insufficient stores of iron. As a result, RBCs do not function normally and are destroyed. Iron deficiency anemia can be either iron deficient or non-iron deficient.
If the client has iron levels below normal but is not anemic, they may have iron deficiency anemia. If RBCs cannot function normally because of a lack of iron stores, it is classified as iron-deficient anemia. This is the most common type of anemia.
Iron deficiency anemia may also be caused by the absorption of nutrients in the gastrointestinal tract, leading to iron deficiency (ANA, 2008; Epstein & Harris, 2000). In addition to lack of iron in the diet, other factors that can contribute include:
• Celiac disease and other intestinal disorders
• Inflammatory bowel disease (IBD): Crohn’s Disease, ulcerative colitis, tropical sprue
• Pernicious anemia: lack of intrinsic factor which leads to vitamin B12 malabsorption
• Drug-induced: folic acid antagonists
The following are the nursing diagnoses for Iron Deficiency Anemia:
• Altered nutrition due to decreased appetite secondary to anorexia
• Ineffective circulating volume in which the body cannot retain fluid and is at risk for dehydration, electrolyte imbalance, hypovolemic shock, heart failure (HF)
• Impaired physical mobility due to weakness and weariness
• Malnutrition: less than body requirements secondary to lack of appetite related to anorexia, weight loss, and GI upset or pain.
• Constipation related to chronic use of loperamide (Imodium) for constipation; if used continuously, the client is at risk for dependence and chronic constipation since loperamide does not promote normal GI motility.
• Acute pain due to GI upset and inflammation of the bowel secondary to ulcerative colitis or Crohn’s disease
• Chronic pain due to arthritis, joint stiffness from lack of calcium/vitamin D, osteoporosis if inadequate intake is present; secondary to anorexia if weight loss occurs.
• Alteration in comfort linked to fatigue related to anemia-induced weakness
• Sexual dysfunction due to chronic tiredness linked to anemia—less interest in sex and more fatigue
• Anxiety due to fear of death or losing a loved one. Frequent blood draw for lab work may aggravate anxiety in the patient.
• Insomnia due to fatigue linked to anemia-induced weakness where chronic lack of sleep leads to increased fatigue and worsening of the disease
• Delayed growth and development in children as iron plays a role in hemoglobin production and muscle development
• Impaired social interaction due to tiredness, anxiety, irritability due to anemia—exhaustion may cause decreased interest in social activity or conversation.
Megaloblastic is caused by the inability of Red Blood Cells (RBCs) to mature fully. It is often seen with vitamin B12 deficiency when the intrinsic factor does not absorb the vitamin. A lack of inherent characteristics is also associated with pernicious anemia.
It can also be seen as a result of a folic acid deficiency or certain drugs such as phenytoin. In this condition, the red blood cells are larger than normal in size and have less hemoglobin per cell (hemoglobin M disease).
The bone marrow produces large, immature blood cells, which eventually produce a macrocytic (large cell) anemia.
- Deficient knowledge [Vitamin B12]
- Acute pain linked to injections of vitamin B12
- Urinary retention related to return of intrinsic factor function
- Fatigue due to immaturity of red blood cells and increased circulation time
- Respiratory alkalosis due to excessive production of carbon dioxide (CO)
- Dyspnea (difficulty in breathing) due to increased number of RBCs.
Sickle cell anemia is a genetic disease that primarily affects red blood cells (RBCs). In normal RBCs, a protein called hemoglobin binds oxygen in the lungs and releases it to tissue when tissues are hypoxic. The condition occurs because of an abnormal hemoglobin gene inherited from one or both parents.
Hemoglobin is composed of protein and heme, a chemical that gives red blood cells their color.
In the sickle cell, the hemoglobin molecule does not form properly and becomes deformed when it folds. When this happens, RBCs become stiff and change shape, causing them to stack up in narrow vessels, blocking circulation.
The red blood cells change from round to a sickle shape and cannot pass through narrow vessels, often getting stuck in capillaries.
The abnormal hemoglobin also cannot carry oxygen. Therefore the cells and tissues throughout the body are deprived of oxygen (McGrawHill 2011).
• Altered health related to decreased oxygenation secondary to anemia-induced hypoxia
• Impaired physical mobility due to pain and weakness from ischemia, infarcts, joint stiffness, muscle cramps in lower extremities due to the disease.
• Chronic pain linked to ischemia, infarcts, joint stiffness, muscle cramps in lower extremities due to the disease.
• Acute pain due to vaso-occlusive crises secondary to occlusion of vessels with RBC sickling; pain often radiates into upper and lower extremities where blood vessels are being occluded.
• Impaired skin integrity due to risk for pressure ulcers, fissures, and infection secondary to pain in the lower extremities with ischemia; muscles contractions may cause tightness of skin due to muscle cramps which can also lead to a breakdown of tissue.
• Sexual dysfunction due to fatigue as a result of the disease; fatigue may lead to sexual dysfunction in males and females.
• Impaired social interaction linked to anxiety secondary to fear of death, scaring others. The nurse teaches the client how to interact outside of the hospital setting and manage their illness.
Aplastic anemia occurs when the bone marrow fails to produce any new blood cells.
• Deficient Knowledge [Patient] related to educational needs regarding medications and procedures.
• Alteration in nutritional status [Pediatric, Acute leukemia] due to decreased oral intake secondary to chemotherapy.
• Impaired physical mobility related to treatment-related side effects (fatigue, pain).
Thalassemia occurs when red blood cells are abnormally small or lacking in hemoglobin. Hemoglobin is the iron-containing protein in red blood cells that absorbs oxygen and releases it to body tissue for use.
– Fear linked to the unknown (prognosis) and the possibility of requiring a lifelong blood transfusion regimen.
– Deficient Knowledge [Patient] due to the disease process, potential complications, and treatment options.
– Impaired Physical Mobility due to laboratory monitoring (blood tests).
Understands the diagnosis of anemia, treatment, and nursing interventions required to treat anemia.
Liaise with other members of the multidisciplinary care team regarding established plans and protocols.
Monitor patient for symptoms associated with anemia (e.g., fatigue, malaise).
Implement therapeutic regimens as prescribed, including iron infusions.
The nurse should ensure timely completion of required laboratory testing to monitor the patient’s progress (e.g., CBC, reticulocyte count).
Monitor safety parameters related to cancer treatments and interventions (e.g., STI prophylaxis protocols).
The nurse may identify the following interventions to prevent and treat anemia:
Assess the patients’ vital signs, including their pulse rate, respiratory rate, temperature, and skin turgor, as well as check their weight for malnutrition or dehydration.
-Physical examination looking for any abnormal findings such as pallor or jaundice, which would indicate an underlying disease process that might contribute to the anemic state.
-Order lab tests including complete blood count (CBC) with differential, reticulocyte count, and platelet count to evaluate and determine if the patient is anemic.
-Request for bone marrow exam- This test is used to examine the bone marrow for signs of infection, inflammation, or malignancy. The bone marrow is where new blood cells are made and stored in the body.
-Provide education about any medications prescribed and follow-up visit appointments and diet restrictions based on the type of anemia.
-Encourage the patient to eat adequate calories. There are necessary vitamins they need from their diet that will help them feel better.
-Client education utilizing health-promotion strategies (e.g., increasing intake of iron-rich foods) before any signs of anemia develop
-Phlebotomy or blood replacement therapy for chronic disorders resulting in significant bleeding (e.g., hemophilia, GI bleeding, aplastic anemia)
-Transfusion of packed red cells for clients with severe acute blood loss due to trauma or surgery. Serum ferritin determination may help identify clients who are at risk for developing iron-deficiency anemia
-The nurse should give Iron supplements, especially to clients with low body store or those in whom absorption is impaired (ANA, 2008). A dietitian can also determine if patients need a multivitamin.
-Encourage the patient to take supplements as prescribed.
The nurse should also evaluate the client for complications. Common complications of anemia are:
Heart failure – pump function decreases due to insufficient oxygen reaching the heart, resulting in swelling of the feet, ankles, and legs.
Pulmonary edema – fluid accumulates in the lungs due to reduced circulation and blood flow. This may prevent oxygen from reaching the tissues of the body, resulting in shortness of breath.
Stupor – a feeling of lethargy with decreased reflexes that causes a client to be less alert
Syncope – a feeling of lightheadedness or dizziness with bluish discoloration of the hands and feet
Heart attack – pump function decreases due to insufficient oxygen reaching the heart; this can result in swelling of the feet, ankles, and legs.
Bone pain and fractures – weakened bones can cause pain and may predispose the individual to a fracture.
Standard treatment for anemia include:
Blood transfusions – RBCs are given to increase hemoglobin and hematocrit levels; they may be used in acute blood loss, surgery, or chronic anemia.
Iron supplements – Oral iron preparations have been available since 1982, following the successful administration of parenteral iron. Iron is an essential mineral required for synthesizing hemoglobin, which transports oxygen to the body’s tissues.
Transferrin – A protein that binds two atoms of iron within the blood; transferrin allows iron to be carried from one place to another in the body.
Serum ferritin – Iron storage protein in the bone marrow; a decreased serum ferritin level can indicate iron deficiency anemia.
Anemia is a condition in which the body does not have adequate red blood cells, hemoglobin, or both to function normally. When this happens, oxygen cannot be effectively delivered throughout the body, causing many undesirable symptoms. The causes of anemia are numerous and vary depending on the individual’s age, health status, or condition.
In clients with a history of liver disease (e.g., hepatitis B) or who regularly abuse alcohol, nurses should monitor for signs and symptoms of encephalopathy. These clients are at risk of developing a deficiency in thiamine.
In clients with anemia caused by blood loss, nurses should be aware of the possibility of severe bleeding episodes and provide education for caregivers to prevent or control these incidences.